Compendium ofDrug Abuse Jargon

Ronald P. Evens, PharmD William Clementi, BS (Pharm) San A nton io and A ustin , Texas

Drug abuse slang is an originative and a protean language, which poses the problem of identification and definition of terms. This compilation of nomenclature provides an extensive list to serve as a resource for the busy family physician, who frequently deals with drug abuse problems.

Despite efforts by the government and in the private sector to identify drug abuse problems and collate the terminology of the “drug culture,” the resultant lists of nomenclature usually describe only the “top 100 or 50” terms. This severely limits their useful­ness as a resource tool because a significant proportion of the terms are already familiar to practitioners while a vastly greater number of terms in use do not appear on the lists at all. Therefore, we have accumulated and defined an extended list of drug abuse phrases and jargon from several exist­ing references and from individuals knowledgeable about drug abuse. The review describes over 325 terms

From th e D e p a r tm e n t o f P h arm a co lo g y , University o f T e x a s H e a lth S c ience C e n te r at San A n to n io and th e D e p a r tm e n t o f Pharmacy, U n ive rs ity o f T e x a s a t A u s tin . Requests fo r re p rin ts sho u ld be addressed to Dr. R onald P. Evens, D e p a r tm e n t o f Pharm acology, U n iv e rs ity o f T e x a s H e a lth Science C e n te r a t San A n to n io , 7 7 0 3 F lo y d Curl Drive, San A n to n io , T e x 7 8 2 8 4 .

encompassing the following abuse agents: alcohol, glue, hallucinogens, narco tics, sedative-hypnotics, and stimulants; and the street slang em­ployed in association with their distri­b u tio n and administration, and reactions to them.

The difficulty in comprehension of this specialized lingo is primarily due to its protean nature and the continual generation of new terms. Different subpopulations in the drug abuse cul­ture use dissimilar, changeable subsets of this nomenclature, and newly created terms filter through abuse groups at variable rates. Out-dated jargon in a college crowd, for example, may be new language to a high school group. Further confusion in term defi­nition is caused by the multiple slang designations for a single drug and the multiple meanings for a single slang word or phrase. In addition, the colloquialism and regionalism of our society’s language also increase the variability of this jargon. Finally, the malevolent search for new drugs for abuse from botanical sources, the chemist’s laboratory, and even house­hold items continually generates new nomenclature.

The list on the following pages is organized in alphabetical sequence according to the drug abuse term.

References1. K o n n e r D D , R u b in I: T h e p h a rm a ­

cist's drug abuse m an u a l. P h arm a cy T im es 3 9 :3 5 -3 7 , 1 9 7 3

2 . N a rc o tic s Id e n t if ic a tio n G u id e . R ic h m o n d , V a , Ju m p S tre e t, T h e D rug T re a tm e n t P rog ram o f th e M ed ica l C o llege o f V irg in ia , 1 9 7 0

3 . S o m e Substances Used fo r N o n - prescribed D rugging E ffects . W ash ington , D C , P h arm a ceu tica l M a n u fa c tu re rs Associa­t io n , J a n u a ry , 1 9 7 3

4 . US D e p a rtm e n t o f H e a lth , E d u ca­tio n , and W elfa re , H e a lth Services and M en ta l H e a lth A d m in is tra tio n : L S D . PHS P u b lic a tio n 1 8 2 8 . W ash in g to n , D C , US G o v e rn m e n t P rin tin g O ff ic e , 1 9 6 9

5. S o u th w ic k W W : Inha lan ts -S o lvents . D o w n e rs G ro ve , III , K w ik -F a c , M ed ia Publishers, 197 1

6 . S o u th w ic k W W : Speed, C o caine,and O th e r S tim u la n ts . D o w n e rs G ro ve , III , K w ik -F a c , M e d ia Publishers, 1971

7 . S o u t h w i c k W W : B a rb itu ra tes .D o w n e rs G ro ve , I I I , K w ik -F a c , M ed ia P u b­lishers, 1 97 1

8 . S o u th w ic k W W : H e ro in . D o w n e rsG ro ve , III , K w ik -F a c , M ed ia Publishers, 1971

9. B lakeslee A : W h a t Y o u Can D o A b o u t D angerous D rugs. N e w Y o rk , A ssoci­ated Press, 1 9 7 1 , pp 2 0 -2 1

10 . E in ste in S: T h e Use and M isuse o f Drugs. B e lm o n t, C a lif, W a d s w o rth P u b lish ­ing C o , 1 9 7 0 , pp 1 -7 2 , 7 9 -8 4

11 . M a u re r D W , Vo gel V H : N a rc o tics and N a rc o tic A d d ic tio n , ed 4 . S p rin g fie ld , I I I , C harles C T h o m a s , 1 9 7 3

12 . R ic h te r R W (e d ): M ed ica l Aspects o f D ru g A b use. N e w Y o rk , H a rp e r and R o w , 1 9 7 5

T H E J O U R N A L O F F A M IL Y P R A C T IC E , V O L . 4 , N O . 1, 1 9 7 7 6 7

C om pendium o f Drug Abuse Jargon

Street Name1-12D efin itio n Street Name D e fin itio n

A b .................................... . Abscess w hich form s at site o f Bush ................................ . Marijuana

in jection B u s te d ............................. . To be caught, usually arrested, by

Acapulco G o l d ............. . Mexican marijuana (extrem ely po tent)

local au thorities or to be caught by parents

A cid ................................ . Lysergic acid d ie thy lam ide (LSD) or other hallucinogens

Businessman's Special . . M etham phetam ine;d im e th y ltryp ta m in e (DM T)

A cid H e a d ....................... . One who takes LSD on a (hallucinogen)

regular basis B utte r ............................. . Marijuana

A lley Juice .................... . M ethyl alcohol B u t t o n ............................. . Peyote b u tto n ; tops o f marijuana

A m id o n e ..........................Angel Dust ...................

. Methadone

. Phencyclid ine hyd roch lo ridesprinkled on parsley or marijuana

C .......................................Cabal l o .............................Cactus .............................

p lan t flow er

. Cocaine

. Heroin

. PeyoteB a g .................................... . A small q u a n tity o f e ither heroin or Cadet ................................. . New add ic t

cocaine packaged in cellophane C aliforn ia Sunshine . . LSD (hallucinogen)envelopes C a n ................................ . One ounce o f marijuana

Bang ................................ . The exh ila ra tion experienced after Candy .......................... . Barbiturates; p ills in generaldrug adm in istra tion C a n d y m a n ................... . Dealer o r pusher o f addicting drugs

Barbs ................................ . Barbiturates Canary .......................... . PentobarbitalB e n n ................................. . Am phetam ine sulfate Cashing-A-Script . . . . Getting a forged o r bogusBelongs .......................... . On the habit prescription order dispensedBennies .......................... . Benzedrine (amphetamine sulfate) C a rtw h ee ls .................... . Am phetam ine tabletsBernies F la k e ................ . Cocaine Catch Up .................... . W ithdraw al processBhang ............................. . Marijuana, smoking pipe CD ................................ . G lu te th im ide tab le tBinge ................................ . An extended period o f continued Cecil ............................. . Cocaine

consum ption o f alcohol C h a r l ie .......................... . CocaineB itte r ................................. . Paregoric C h ie f ............................. . MescalineBlack Beauties ............. . Amphetam ines C hipp in '; Chipper . . . Subcutaneous adm in is tra tion o fBlack Hash ................... . Hashish con ta in ing op ium small dose o f heroin;Black R u s s ia n ................ . Hashish (po ten t, dark) “ weekend user" w ho used drugsBlack S tu ff ................... . O pium , prepared fo r smoking less than da ilyBlackjack ....................... , Paregoric w hich has been prepared Cleared Up ................ . To have w ithdraw n from drugs

to be injected C o a s t in g ....................... . Under drug influenceB la n k s ............................. . Poor q u a lity merchandise Cohobe ....................... . DM T in powdered seedsB lo tte r A c id .................... . LSD on paper (hallucinogen)B low Charlie or Snow . . S n iff cocaine C o k e ............................. . CocaineBlow H o r s e .................... . S n iff heroin Cokom o (Kokom o) . . CocaineBlow Weed .................... . To smoke marijuana Cold Turkey ............. . W ithdrawal processBlue Birds ....................... . A m obarb ita l capsules Come Down; Crash . Dissipation o f drug effectsBlue Devils .................... . A m obarb ita l capsules Connect ....................... . Make a purchaseBlue H eave n .................... . Am obarb ita l capsules Cook It U p ................ . To prepare a drug fo r in jectionB o g a r t ............................. . N ot to pass the " jo in t " to a

neighborC o o k e r .......................... . The apparatus used to heat and

dissolve a drug p rio r to in jectionB o m b id o .......................... . Injectable amphetamine (spoons or b o ttle top )B o m b it a .......................... . Methamphetamine C o p ................................ . . To obta in a small q u a n tity o f aB o y ................................ . Heroin drugB r i c k ............................. . Marijuana compressed, usually fo r C o ffin .......................... . . Tobacco

purposes o f transport C o -p ilo ts ....................... . . Amphetam inesBrody .......................... . A f i t o r spasm staged by an addict Courage Pills ............. . . Barbiturates

to e lic it sym pathy C ra n k s .......................... . . MethamphetamineB ro w n s .......................... . Am phetam ine tablets Crap ............................. . . Heroin o f weak potencyBull J i v e ....................... . Marijuana heavily cu t w ith tea. C ry s ta l .......................... . . Methamphetamine

catn ip, or other im purities Cube (The) ................ . . LSDB u m m e r ....................... . A bad tr ip or experience C u t ................................ . . To adulterate w ith agents such asBurned ..........................Burned O u t ................

. Received fake narcotics

. Sclerotic blood vessel fro m toomany in jections; relative overdose;

qu in ine, m ilk sugar

addict who tires o f abuse "hassle" and tries to stop drug abuse

Daytop Lodge . . . . . . Drug abuse treatm ent center directed by ex-addicts

68 T H E J O U R N A L O F F A M IL Y P R A C T IC E , V O L . 4 , N O . 1, 1977

Compendium of Drug Abuse Jargon (continued)

Street Name Definition Street Name Definition

Dealer .................................One who sells drugsD e c k ....................................Packet o f cigarettes, narcotics, etcD ( B ig ) .................................LSDDET ....................................D ie thy ltryp tam ine (hallucinogen)D ia n e ....................................Meperidine hyd roch lo rideD e x ie s .................................D extroam phetam ine sulfate

(Dexedrine)D M Z ....................................Benactyzine (hallucinogen)D M T ....................................D im e th y ltryp ta m ine (Businessman's

Special) (hallucinogen)D o e ....................................... M etham phetam ineDolls; D o l l ie s ....................MethadoneD O M ....................................4 -m ethy l-2 ,5 -D im ethoxy-

am phetam ine (s tim u lan t — STP) D ooJe e .................................HeroinDouble T r o u b le .................C om bination o f both am obarbital

sodium and secobarbital sodiumDoper .................................Regular drug abuserD o w n e rs ..............................Sedatives, usually barbituratesD re a m e r..............................MorphineDream S t ic k .......................An op ium pipeD ro p p e d ..............................Consumed a drug abuse agentDT's ....................................D e lirium tremens (acute alcohol

w ithdraw al syndrome)D u d s ....................................Bags o f heroin con ta in ing no

narcotic agentDust ....................................Heroin; cocaineDust o f A n g e ls ................ Phencyclid ine base (hallucinogen)Dynamite ..........................High grade narcotics;

heroin, cocaineDummy ..............................Drug purchase w ith o u t purported

con ten t

Emma (Miss) ....................MorphineEmsel .................................M orphineEyeopeners .......................Amphetam ines

F a g .......................................TobaccoF-40s .................................SecobarbitalF i x .......................................To in ject drugs; satiate addictive

needsF iz z ie s .................................M ethadone tabletsF la k e ....................................CocaineFlake O u t .......................... To pass o u t fro m drug useF la s h ....................................Rapid, intense, euphoric reactionF lo w e r .................................MarijuanaFlying Saucers ................ PCP, phencyclid ine (hallucinogen)Footballs ..........................Am phetam ine tabletsF la s h b a c k .......................... Recurrence o f some feature o f a

previous LSD experienceF re a k ....................................A n add ic t who enjoys playing w ith

the needleFreak o u t .......................... To be intensely affected by

something

G a n ja ....................................Jamaican marijuana

Garbage ..............................Poor q u a lity merchandiseGarbage H e a d ....................Ind iv idual w ho takes any k ind o f

drugGear . . . ..........................Drugs in generalGee Head .......................... Paregoric userGet I t T o g e th e r ................ To become m enta lly organizedGet O ff ............................. To in it ia lly experience the effects

o f a drug

G ift o f the Sun God . . . CocaineGlad Rag ..........................C lo th or handkerchief th a t is

saturated w ith a material to be inhaled (eg, fo r use in glue sn iffing)

Gold D u s t .......................... CocaineGoofballs .......................... Am phetam ineG r a m ....................................Q uan tity o f hashishG ra s s ....................................MarijuanaG rasshopper.......................A marijuana userGreezy A d d ic t ................ Drug abuser who w ill take

any drug, anytim eG riffo .................................Marijuana

H .......................................... HeroinH a b i t ....................................Dependence upon drugsHappy Trails ....................CocaineHard S t u f f ..........................MorphineH arry; Big H arry; Hairy . HeroinHash ....................................Hashish (TH C), resin fro m top of

Cannabis sativaHash O i l ............................. Concentrate extracting hashH e a d ....................................User o f drugsHearts ................................ Am phetam ineHeavenly Blue ................ LSD (hallucinogen)Heavy Grass High . . . . S trong, stuperous reaction to

marijuanaHemp .................................Marijuana (Cannabis sativa or

indica)High ....................................S tim u lan t tr ipH iko ri, K iku li,

Huatari, W okouri . . . . PeyoteH i t .......................................Make a purchase; take a dragH itting U p .......................... In jecting drugsHocus ................................ MorphineH o g .......................................Phencyclid ine m ixed w ith vegetable

m aterial; veterinary tranqu ilize rHolding ............................. Drugs are in user's possessionHooked ............................. A dd ic ted to drugsHop H e a d ..........................Person who smokes op ium ; addictH orror D r u g .......................Belladonna preparationsH o rs e ....................................HeroinH ot Shot ..........................Poisons concealed in injectable

narcotics fo r the purpose o f hom icide

H y p e ....................................A needle addict

Ice Cream H abit .............Small, irregular drug useId io t Pills ..........................BarbituratesIn A c tion ..........................To seek narcotics

T H E J O U R N A L O F F A M I L Y P R A C T IC E , V O L . 4 , N O . 1, 1 9 7 7 6 9

Compendium of Drug Abuse Jargon (continued)

Street Name Definition Street Name Definition

In -B e tw e e n s ................ . Barbiturates, in com bination w ith Mescalito ....................... Peyote; mescalineamphetamines M eth; Methedrine . . . M etham phetam ine

Indian Hay ................ . Marijuana Mickey Finn ................ Chloral hydrate and alcoholIn F l ig h t ....................... . To be very high from drugs. M in d b io w e r .................... A hallucinogenic drug

especially m etham phetam ine M onkey; M o rf; M orpho Morphinehydroch lo ride (M ethadrine) M o th e r ............................. The drug peddler

M o o n sh in e ....................... E thy l alcoholMooters .......................... Marijuana

j .................................... . Marijuana cigarette M ounta in D e w ............. A lcoholJabber .......................... . A needle addict Mud ................................. S tram onium preparation m ixedJammed U p ................ . An overdose w ith carbonated beverageJ iv e ................................ . Marijuana Muggles .......................... Crude marijuana before ro lled in toJo in t ............................. . Syringe and needle; one stick of cigarette

marijuana; or an op ium smoker's Mushrooms;den Sacred Mushrooms;

Jo lly Babies, Beans . . . Am phetam ine Magic Mushrooms . . Psilocybin (hallucinogen)Joy Juice .................... . Chloral hydrate Mutah ............................. MarijuanaJoy P o p p in g ................ . Narcotic in jections under the skin M o h a s k y .......................... MarijuanaJoy P o w d e r ................ . Heroin Mu .................................... MarijuanaJ u ic e ............................. . A lcoholJuice Freak ................ . One who prefers alcoholJugs ............................. . Injectable amphetamines N a rc s ................................. Federal narcotics agentsJ u n k ............................. . Narcotics N e m m ie s .......................... Y e llow capsules o f pentobarb ita lJunkie .......................... . Heroin abuser Nickel B a g ....................... A five-do llar bag o f a drug

N im bie; Nimbles . . . . BarbituratesN o s e ................................ Cocaine

K ick ............................. . EuphoriaK ick In d u c e rs ............. . Cough e lix irs (alcohol)K icking ....................... . W ithdrawal processK ilo ............................. . Tw o pounds o f marijuana Odyssey H o u s e ............. Drug abuse trea tm ent centerK if ................................ . Marijuana O D .................................... Overdose; death

On .................................... Using drugsOn the N o d .................... Drowsiness fro m narcotics

L a y ................................. . An op ium den Ounce ............................. 30 grams o f marijuanaLayout .......................... . Equipm ent fo r in jecting drugs; O u tf it ............................. N arcotic in jection equipm ent

op ium smoker's o u tf itLeaf ( T h e ) ................... . CocaineL e m o n .......................... . Bad or fake dopeLicorice ....................... PCP; Peace Pill ............. Phencyclid ine (hallucinogen)

L i d ................................ . 3 /4 oz o f marijuana Panama R e d .................... Hashish; marijuana

Lid P o lle rs .................... . Amphetam ines Papers ............................. Papers usually used to ro ll a

Lords ............................. . H ydrom orphone hydroch lo ride marijuana cigarette. Popular

Love Drug ................... . M D A (m ethyld ioxyam phetam ine) brands include: Zig-Zag,

LSD ............................. . Lysergic acid d iethylam ide W heatstraw, Papel del T rigo ,

(hallucinogen) Bambu, Job, Roach, Tops

Luding O u t ................ . S tupor produced from alcohol and Peace ................................ STP

methaqualone Peaches .......................... Am phetam ine tablets

Lumber ....................... . Marijuana stems w hich are found in Peanuts .......................... Barbiturates

an ounce o f marijuana Pearly G a te s .................... Morning g lory seeds

M .................................... . M orphine Phoenix H o u s e ............. Drug abuse trea tm ent centerM D A ............................. . 3 ,4 -m ethyld ioxyam phetam ine Pep P i l l s .......................... Amphetam ines

(hallucinogen) Pethidine ....................... Meperidine hyd roch lo rideM ain liner ................... . One who injects d ire c tly in to the P h e n n ie s .......................... Barbiturates

vein PG; P O ............................. ParegoricMary J a n e .................... . Marijuana Pimp's D r u g ................... CocaineM e s c ............................. . Mescaline (hallucinogen) Poppies .......................... Flowering p lan t fro m w hich op iumMescal B u tton ; is derived

Mescal Beans . . . . . Peyote; mescaline P o t .................................... Marijuana

7 0 T H E J O U R N A L O F F A M IL Y P R A C T IC E , V O L . 4 , N O . 1 , 1977

Compendium of Drug Abuse Jargon (continued)

Street Name Definition Street Name Definition

Quill .................................... M atchbook cover fo r sn iffing S t i c k ....................... Marijuana cigarettecocaine Stoned ....................... Under the influence o f narcotics

Straw; Smoke; Splim . . MarijuanaStraight ............................. Describes one who avoids the use o f

R a in b o w ............................. A m obarb ita l and secobarbitalcapsule (red and blue) Strung O ut ....................... In need o f a f ix , sedative, tr ip ;

Reader ................................. P rescription orderReader W ith T a i l ............. Forged prescription order S T P .......................... D im ethoxym ethylam phetam ineReds; Red Devils; (DOM — hallucinogen)

Red Birds (capsules) . Barbiturates, secobarbital Sugar .................................... LSD; heroinR e e fe r ................................. Marijuana cigarette Syndicate A c i d ................ STP (hallucinogen)Rich Man's D r u g ............. Cocaine Synthe tic Marijuana . . . Phencyclid ine (hallucinogen)Roach ................................. B u tt o f marijuana cigarette S w e e tie s ............................. Phenmetrazine hyd roch lo rideRoll .................................... T o make a marijuana cigarette (stim ulant)R oses.................................... Am phetam ine tablets Synanon ............................. Drug abuse treatm ent center,Royal Blue ....................... LSD directed by ex-addictsRun .................................... Period o f s tim u lan t abuseR u s h .................................... Rapid, intense, euphoric reaction

T a b ....................................... General term to describe drug o f

Safe .................................... A d d ic t feels protected from solid dosage

problems and challenges o f life Texas T e a .......................... Marijuana

during tr ip THC .................................... Tetrahydrocannabino l (hallucinogen

Scag; Scat; Smack; S tu ff Heroin in marijuana and hashish)

S c h o o lb o y .......................... Codeine T o k e .................................... Inhalation o f smoke

S c o re .................................... To establish a connection w ith a Tops .................................... Peyote

dealer Track D r iv e r s .................... Amphetam ines

Script ................................. P rescription order Tracks; Tu rkey Tro ts . . Marks and scars fro m the use o f a

Script W riter .................... Sym pathetic physician; one who hypoderm ic needle

forges Rx orders T ra n q u ility ....................... STP, hallucinogen

Seggy; Seccy .................... Barbiturates Travel Agent ................... LSD seller

Seni .................................... Peyote Trips; T r ip p in ' ................ High mediated by LSD

Serenity ............................. STPSharps ................................. NeedlesShoot Up .......................... To in ject drugsShooting G a l le r y ............. Place where addicts in ject drugs Unkie ................................ Morphine

Sickle ................................. College student using drugs U p p e rs ................................ S tim ulants

Skin P o p ............................. Intraderm al or subcutaneousin jection

Sleepers ............................. BarbituratesS nappers ............................. A m yl n itr ite ampules W a k e -u p ............................. Amphetam inesS n a r f .................................... Nasal inha lation o f cocaine W a s te d ............................. ... Under influence o f drugsS n o r t .................................... Inha la tion through nose Water P ip e .......................... Device fo r bubbling smoke throughS n o w .................................... Cocaine water fo r cooler inhalationSopors (R) ....................... Methaqualone Wedding B e l ls ................... LSDSpaced; Spaced O ut . . . A ltered consciousness W e e d .................................... MarijuanaSplash ................................. Methamphetamine W hite Lady ....................... HeroinSpeed ................................. Metham phetam ine usually, bu t W hite Lightn ing ............. E thy l alcohol; also name fo r a

may be any stim u lant specific speed drugSpeed Freak ....................... Am phetam ine abuser (or amphetamine)Speed ball .......................... Heroin and cocaine m ix tu re ; also W h i te s ................................. Am phetam ine tablets

Percodan and m ethadrine W hite S t u f f ....................... M orphine; heroinSpoon ................................. A gram o f cocaine W indowpane ................... LSDS ta rd u s t ............................. Heroin w ith cocaine W ire d .................................... In tox icated state due to marijuanaStar Spangled Powder . . CocaineS p ik e .................................... Needle fo r in jectionStash .................................... Collective term fo r the

accum ulation o f marijuana Yellows; Y e llow Jackets . Pentobarbital capsulesparaphernalia Yen S le e p .......................... Som nolent stage during drug

Stepped-on ....................... Process o f d ilu tin g abuse drugs w ithdraw al

T H E J O U R N A L O F F A M I L Y P R A C T IC E , V O L . 4 , N O . 1, 1 9 7 7 71

C ontinued from page 62

N .Y .S .2 d 3 , 1 4 3 N .E .2 d 3 (1 9 5 7 )6 4 . D a rlin g v C h arles to n C o m m u n ity

M e m o ria l H o sp ., 3 3 l ll .2 d 3 2 6 , 21 1 N .E .2 d 2 5 3 (1 9 6 5 ) , cert, d e n ie d , 3 8 3 U .S . 9 4 6 (1 9 6 6 )

6 5 . B ader v U n ite d O rth o d o x S y n a ­gogue, 1 4 8 C o nn . 4 4 9 , 1 7 2 A .2 d 1 9 2 , 1 9 4 (1 9 6 1 )

6 6 . E d w ard s v G race H o sp ita l S o c ., 1 3 0 C o n n . 5 6 8 .3 6 A .2 d 2 7 3 (1 9 4 4 )

6 7 . S o u th w ic k , supra n o te 1 2 , a t 4 6 56 8 . Id , a t 4 3 7 . I t should also be

p o in te d o u t th a t th e c o rp o ra te d u ty to c o n tro l a p h y s ic ian 's m ed ica l care does n o t req u ire th e in s titu t io n to v io la te s tatutes th a t p ro h ib it th e c o rp o ra te p rac tice o f m ed ic in e . A rg u in g th a t it does is, " . . . m ere sem an tic t r ic k e ry ." R a p p , D a rlin g and its Progeny: A R ad ica l A p p ro a c h T o w a rd H o s­p ita l L ia b i l i ty , 6 0 III . B.J. 8 8 3 , 8 9 0 -9 1 (1 9 7 2 )

6 9 . H e d g ep e th , D a rlin g R e v is ited , 4 6 J A m Hosp Assn 5 8 (A u g u s t, 1 9 7 2 )

7 0 . See t e x t acc o m p an y in g notes 1 6 1 -1 6 3

7 1 . S o u th w ic k , supra n o te 4 1 , a t 10 47 2 . S o u th w ic k , supra n o te 4 5 , a t 1617 3 . B ing v T h u n ig , 2 N .Y .2 d 6 5 6 , 1 6 3

N .Y .S .2 d 3 , 1 4 3 N .E .2 d 3 , 8 (1 9 5 7 )7 4 . G ro u p H e a lth C o o p e ra tiv e o f Puget

So und v. K ing C o u n ty M ed ica l S o c ., 3 9 W ash.2d 5 8 6 , 6 0 4 , 2 3 7 P .2d 7 3 7 , 7 4 7 (1 9 5 1 )

7 5 . W . C u rran & G . M o se ley , supra n o te 1, a t 6 -8 ; and see S o u th w ic k , supra note 4 1 , a t 9 3 , w h e re Professor S o u th w ic k ind icates th a t h osp ita l l ia b il ity is in flu en ced by th e a d d it io n o f p re v e n tiv e h ea lth p ro ­gram s (e q u iv a le n t to a G P H P ) because th is added fu n c t io n is a fu r th e r in s t itu t io n a li­za tio n o f th e d e liv e ry system

7 6 . Id .7 7 . A spen S ystem s C o rp . H e a lth L aw

C e n te r, D igest o f S ta te Law s. A ffe c t in g th e P re p a y m e n t o f M ed ica l C are , G ro u p Prac tice and H M O 's , A p p . F " l ia b ilit ie s o f H M O 's , A -1 8 1 , A -1 9 4 ; W . C u rran & G . M o se ley , supra n o te 1, a t 1 0 8 ; A n n o .," H o sp ita l's L ia b ility fo r N egligence in F a ilin g to R e ­v ie w ," supra n o te 6 2 , a t 8 7 5 -7 8

7 8 . W . C u rran & G . M o se ley , supra n o te 1 , a t v iii, 7 5 , 8 5 , 8 6 , and 1 0 5 . F o r e x a m p le , a C a lifo rn ia ju ry aw arded $ 7 3 0 ,0 0 0 dam ages to a w id o w and c h ild re n against K aiser F o u n d a tio n H o sp ita ls in an in s titu t io n a l m a lp ra c tic e su it w h e re p la in ti f f co n ten d ed th a t th e m ed ica l a t te n tio n given to th e deceased w as fra g m e n te d b y th e Kaiser system o f m ed ica l care in w h ic h no single d o c to r w as fo llo w in g th e p a tie n t nor w as in c o n tro l o f th e deceased's case. Larson v Kaiser F o u n d a tio n H o sp ita ls , N o . 4 3 2 3 8 (C al. S u p er. C t . , S a n ta C lara C o ., A p ril 9 , 1 9 7 3 )

7 9 . P u rce ll v Z im b e lm a n , 1 8 A r iz . A p p . 7 5 ,5 0 0 P .2d 3 3 5 (C t. A p p . 1 9 7 2 ); M o o re v B oard o f Trustees o f C a rs o n -T ah o e H osp., 8 8 N e v . 2 0 7 , 4 9 5 P .2d 6 0 5 (1 9 7 2 ) , c ert, d e n ie d , 4 0 9 U .S . 8 7 9 (1 9 7 2 ) ; see also S o u th w ic k , supra n o te 1 2 , a t 4 3 6 -3 8 , 4 5 0 - 5 1 ,4 6 4

8 0 . 7 N .Y .2d 5 6 , 1 9 4 N .Y .S .2 d 5 0 9 , 1 6 3 N .E .2 d 3 3 3 (1 9 5 9 )

8 1 . C . F . B ledosoe, D e fe n d in g H o s p ita l- Negligence o f P h y s ic ia n -E m p lo y e e , 19 A m . Jur. T ria ls 4 3 1 ,4 4 2 (1 9 7 2 )

8 2 . See id , a t 4 4 2 -4 3 : see also te x t acc o m p an y in g notes 9 1 -1 0 2 in fra

8 3 . P u rce ll v Z im b e lm a n , 18 A r iz . A p p . 7 5 ,5 0 0 P .2d 3 3 5 (C t. A p p . 1 9 7 2 ); W . C u rran & G . M o se ley , supra n o te 1; see also te x t a t notes 8 7 -9 0 in fra

8 4 . S o u th w ic k , supra n o te 418 5 . T e le p h o n e in te rv ie w w ith G eorge

B. M o se ley , I I I , A ssis tan t G eneral C ounsel, M assachusetts E x e c u tiv e O ff ic e o f H u m a n Services, Ju n e 2 4 , 1 9 7 4

8 6 . " T h is legal defense [to a l ia b il ity su it] c le a rly is u n a va ilab le to those several H M O s w h ich d ire c t ly e m p lo y th e ir p h y s i­cians, o r to H M O s w h ic h are so c losely associated w ith th e ir p h ys ic ian groups as to be considered involved in th e p rov is ion o f h ea lth services. I t m ay be th a t H . I .P . , . . . is th e o n ly H M O s u ff ic ie n tly d isassociated f ro m its physic ians to a llo w th e use o f th is d efen s e ." W . C u rran & G . M o se ley , supra

7 2

n o te 1, a t 3 2 , 3 38 7 . Id , a t x -x i; see also H e a lth Services

and M e n ta l H e a lth A d m in is tra tio n , U .S . D e p t, o f H .E .W ., Q u a lity A ssurance o f M edical C are , (M o n o g ra p h , F e b ru a ry , 1 9 7 3 )

8 8 . W . C u rra n & G . M o se ley , supra n o te 1, a t 1 3 8 -1 4 0 ; th e ir re p o rt in d icate d th a t o n ly o ne o f tw e lv e G P H P s surveyed had such a c o n tra c tu a l re q u ire m e n t

8 9 . 5 0 III . A p p .2 d 2 5 3 , 2 0 0 N .E .2 d ,. 1 4 9 , 1 7 9 (1 9 6 4 ) , q u o tin g S e ld o n v C ity o f S te r lin g , 3 1 6 III . O p p .2 d 4 5 5 , 4 5 N .E .2 d 3 2 9 ,3 3 2 (1 9 4 2 )

9 0 . D a rlin g v C h arles to n C o m m u n ity M e m o ria l H o sp ., 3 3 I I I . 2d 3 2 6 , 21 1 N .E .2 d 2 5 3 , 2 5 7 ( 1 9 6 5 ) : accord , S ta n h o p e v Los A ngeles C o lleg e o f C h iro p ra c tic , 5 4 Cal. A p p .2d 1 4 1 , 1 4 6 , 12 8 P .2d 7 0 5 , 7 0 8 (1 9 4 2 ) (1 9 4 2 )

9 1 . Id .9 2 . W . C u rran & G . M o se ley , supra

n o te 1 , a t 69 3 . W . C u rran & G . M o se ley , 19 S tu d y

on Legal Issues in th e R e o rg a n iza tio n o f H e a lth C are In s titu t io n s , 2 2 , 2 3 (1 9 7 4 )

9 4 . B eeck v T u c so n G en. H o sp ., 18 A r iz . A p p . 1 6 5 , 5 0 0 P .2d 1 1 5 3 (1 9 7 2 ) ; Seneris v Haas, 4 5 C a l.2 d 8 1 1 ,2 9 1 P .2d 9 1 5 (1 9 5 5 ) , H e d lu n d v S u tte r M ed ica l Serv . C o ., 51 C al. A p p .2 d 3 2 7 , 1 2 4 P .2d 8 7 8 (1 9 4 2 ) : V a n a m a n v M ilfo rd M e m o ria l H o sp ., In c ., 2 7 2 A .2 d 7 1 8 (D e l., 1 9 7 0 ); S chagrin v W ilm in g to n M ed ica l C e n te r, In c ., 3 0 4 A .2d 61 (D e l. S u per C t. 1 9 7 3 )

9 5 . See te x t a t n o te 7 89 6 . See te x t a t notes 1 2 1 -2 59 7 . See also te x t a t notes 1 0 3 -0 89 8 . Beeck v T ucson G en. H o sp ., 18

A r iz . A p p . 1 6 5 , 5 0 0 P .2d 1 1 5 3 (1 9 7 2 ) ; Seneris v Haas, 4 5 C a l.2 d 8 1 1 ,2 9 1 P .2d 9 1 5 (1 9 5 5 ) ; H e d lu n d v S u lle r M ed ica l S erv . C o ., 51 C al. A p p .2d 3 2 7 , 1 2 4 P .2d 8 7 8(1 9 4 2 ) ; K o b er v S te w a rt, 1 4 8 M o n t. 1 1 7 , 4 1 7 P .2d 4 7 6 (1 9 6 6 ) ; L u n d b erg v Bay V ie w H o sp ., 1 7 5 O h io S t . 1 3 3 , 191 N .E .2 d 8 2 1 (1 9 6 3 )

9 9 . See Beeck v T u c so n G en . H o sp ., 18 A r iz . A p p . 1 6 5 , 5 0 0 P .2d 1 1 5 3 (1 9 7 2 ) ; V a n a m a n v M ilfo rd M e m o ria l H o sp ., 2 7 2 A .2 d 7 1 8 (D e l. 1 9 7 0 )

1 0 0 . Beeck v T ucson G en . H osp. 18 A r iz . A p p . 1 6 5 , 5 0 0 P .2d 1 1 5 3 (1 9 7 2 ) ; Schagrin v W ilm in g to n M ed ica l C e n te r, In c ., 3 0 4 A .2d 61 (D e l. S u p er. C t. 1 9 7 3 ); K o b er v S te w a rt, 1 4 8 M o n t. 1 1 7 , 4 1 7 P .2d 4 7 6 (1 9 6 6 ) . See S o u th w ic k , supra n o te 1 2 , a t 441

1 0 1 . W . C u rran & G . M o s e le y , supra n o te 1, a t 81 -2

1 0 2 . Beeck v T u c so n G e n . H o sp ., 18 A r iz . A p p . 1 6 5 , 5 0 0 P .2d 1 1 5 3 , 1 1 5 9 ( 1 9 7 2 ) ; c o n tra Pogue v H o sp ita l A u th o r ity o f D e K a lb C o u n ty , 1 2 0 G a. A p p . 2 3 0 , 170 S .E .2 d 5 3 , 5 4 (1 9 6 9 ) , w h e re th e G eorg ia c o u rt refused to f in d th e h osp ita l an a p p a r­e n t agent even th o u g h m a n y o f th e above rec ited fa c to rs w e re present, p r im a rily be­cause th e c o n tra c t b e tw een th e d o c to r and hospita l labeled h im as an " in d e p e n d e n t c o n tra c to r ." T h is appears to be a d is t in c tly m in o r ity ru le

1 0 3 . N o te . In d e p e n d e n t D u ty o f a H o s ­p ita l to P rev en t M a lp ra c tic e , 15 A r iz . I. Rev. 9 5 3 , 9 6 7 (1 9 7 3 ) fo r a persuasive su m m ary o f th is a rg u m en t

1 0 4 . W . C u rran & G . M o se ley , supra n o te 1, a t 9

1 0 5 . Id , a t 1 0 , 111 0 6 . Id , a t 7 7 ; c a u tio n , these H M O s

w ith pushy salesm en m o st p ro b a b ly are fo r -p r o f i t o rg an iza tio n s

1 0 7 . T h e e x te n t o f th is p ro b lem is in d ica te d by A n n o t ., 3 6 A .L .R .3 d 541 (1 9 7 1 )

1 0 8 . See N o te , supra n o te 1 0 31 0 9 . A s to breach o f c o n tra c t actions,

see te x t acc o m p an y in g notes 21 -2 5 , supra1 1 0 . G a rfie ld M e m o ria l H o sp ita l v M a r­

shall, 9 2 D .C . A p p . 2 3 4 , 2 0 4 F .2 d 7 2 1 , 37 A .L .R .2 d 1 2 7 0 (1 9 5 3 ) ; Evangelis ta v B lack, 1 0 0 O h io S t. 2 2 3 and 1 0 0 O h io S t. 2 6 4 , 12 6 N .E .2d 71 (1 9 5 3 ) ; G u illia m s v H o lly ­w o o d H o s p ita l, 18 C a l.2 d 9 7 , 1 1 4 P .2d 1 (1 9 4 1 ) ; A n n o t ., supra n o te 6 2 , a t 8 7 5 -7 8

1 1 1 . G . M o se ley , supra n o te 8 51 1 2 . G iu s ti v C . K W eston C o ., 1 6 5 O r.

5 2 5 , 1 0 8 P .2d 1 0 1 0 (1 9 4 1 )1 1 3 . W . Prosser, T h e Law o f T o rts

Continued on page 75

Pcritrate Sfl Sustained Redon(pentaerythrifol tetranitrate) 80mgC AUTIO N: Federa l law p ro h ib its dispensing w ith o u t p re sc rip tio n .D escrip tion : Each ta b le t o f P e ritra te SA Susta ined A c tio n con ta ins : p e n ta e ry th rito l te tra n itra te 80 m g (20 mg in im m e d ia te re lease laye r and 60 mg in susta ined release base). P e ritra te * (p e n ta e ry th r ito l te tra n i­tra te ) is a n itr ic ac id es te r o f a te tra h yd ric a lcoho l (p e n ta e ry th r ito l) .

In d ica tio n s : Based on a re v ie w o f th is drug by the N a tio n a l A cadem y o f Sciences — N a tio n a l Research Council a n d /o r o the r in fo rm a tio n , FDA has c lass ifie d th e indica­tio n s as fo llo w s :

' ’Possib ly" e ffe c tiv e : P e ritra te (p en ta ­e ry th r ito l te tra n itra te ) , is ind ica te d fo r the re lie f o f ang ina p ec to ris (pa in associated w ith co ron a ry a r te ry d isease). It is not in tended to a b o rt the a cu te ang in a l ep isode b u t i t is w id e ly re ga rd e d as use­fu l in the p rop h y lac tic tre a tm e n t o f angina pecto ris .

F inal c lass ifica tio n o f th e less-than- e ffe c tiv e ind ica tion s re qu ire s fu r th e r in ve s tig a tion .

C on tra in d ica tion s : P eritra te -S A Sustained A c tio n (p e n ta e ry th r ito l te tra n itra te ) 80 mg is j co n tra in d ica te d in p a tie n ts w ho have a history o f s e n s itiv ity to th e d rug.W arn ing : Data su pp o rtin g the use o f Peritrate i (p e n ta e ry th r ito l te tra n itra te ) d u rin g the e a rly days o f the a cu te phase o f m yocardia l in fa rc t io n ( th e p e rio d d u rin g w h ich c lin ical a nd la b o ra to ry fin d in g s a re u ns ta b le ) are in s u ffic ie n t to e s ta b lish safety.

This d rug can ac t as a phys io log ica l a n ta g o n is t to n o re p in e p h rin e , acetylcholine, h is tam ine , and m any o th e r agen ts.P recau tions: Should be used w ith caution in jp a tie n ts w ho have g laucom a. Tolerance to th is d rug , and cross-to le rance to o th e r nitrites and n itra te s m ay occur.A dve rse R eactions: Side e ffe c ts re p o rte d to | da te have been p re d o m in a n tly re la te d to ras (w h ich re qu ire s d isco n tin u a tio n o f medication] and headache and g a s tro in te s tin a l distress, w h ich a re usua lly m ild and tra n s ie n t w ith con tin u a tio n o f m ed ica tion . In som e cases severs; p e rs is te n t headaches m ay occur.

In a d d itio n , the fo llo w in g adve rse reaction: to n itra te s such as p e n ta e ry th r ito l tetranitrate j have been re p o rte d in th e l ite ra tu re :

(a ) C utaneous v a s o d ila ta tio n w ith flushing(b ) T ransient ep isodes o f d izziness and

w eakness, as w e ll as o th e r signs of ce reb ra l ischem ia associa ted w ith postu ra l hypo tens ion , m ay occasionally j deve lop .

(c) An occasional in d iv id u a l e x h ib its marker se n s itiv ity to the hypo tens ive effects oi l n it r ite and severe responses (nausea, v o m itin g , w eakness, restlessness, pall:' p e rs p ira tio n and co lla p se ) can occur, j even w ith th e usual th e ra p e u tic doses. A lcoh o l m ay enhance th is e ffec t.

Dosage: P e ritra te SA S usta ined A ction (p e n ta e ry th r ito l te tra n itra te ) 80 m g (b.i.d.o' j an em pty s tom ach), 1 ta b le t im m e d ia te ly on a ris in g and 1 ta b le t 12 hours la te r. Tablets shou ld n o t be chew ed.S upp lied : P e ritra te SA Susta ined A ction (p e n ta e ry th r ito l te tra n itra te ) 80 mg, double layer, b iconvex, d a rk g re e n / l ig h t g reen table in b o ttle s o f 100 (N 0047-0004-51) and 1000 (N 0047-0004-60). A lso in u n it dose —package o f 10 x 10 s trips (N 0047-0004-11).A d d it io n a l Dosage Form s: P e ritra te 20 m g- j lig h t g reen, scored ta b le ts in b o ttle s o f 100 (N 0047-0001-51) and 1000 (N 0047-0001-60! A lso in u n it dose — package o f 10 x 10 strips (N 0047-0001-11). P e ritra te 10 m g —lig h t gree unscored ta b le ts in b o ttle s o f 100 (N 0047- 0007-51) and 1000 (N 0047-0007-60).Full in fo rm a tio n is a v a ila b le on request.

Continued from page 72

4 7 0 -7 4 (4 th ed. 1 9 7 1 )114 Schagrin v W ilm in g to n M ed ica l

Center,’ ln c .f 3 0 4 A .2 d 61 (D e l. 1 9 7 3 )115 G iu s ti v C . H . W esto n C o ., 1 6 5 O r.

525 , 108 P .2d 1 0 1 0 (1 9 4 1 )116 . Id . a t 1 0 1 31 1 7 . G avin v R h o d e Is land H o sp ., 12

p I 411 (1 8 7 9 ) ; see te x t a c c o m p a n y in gnotes 1 2 -1 7 and 6 1 -7 0 , esp ec ia lly 6 7 , fo r discussions o f th e s im ila r ity o f h osp ita l and GPHP purposes

118 . T u n k l v R egents o f U n iv . o f C a l., 60 Cal.2d 9 2 , 3 2 Cal. R p n . 3 3 , 3 8 3 P .2d 441 (1 9 6 3 ); A n n o t ., 6 A .L .R .3 d 7 0 4 , 7 0 5(1 9 6 6 ) ; A n n o t ., supra n o te 6 2 , a t 8 8 0 , Compare p la n /s u b p ro v id e r c o n tra c ts c o n ­tain ing in d e m n ific a tio n clauses in w h ic h th e subproviders save th e p lan harm less fro m m alpractice l ia b i l ity . O n th e ir fa c e , these clauses seem s im ila r in e f fe c t to d isc la im er clauses in p la n /c o n s u m e r co n tra c ts . B u t such in d e m n ific a tio n clauses sho u ld usually be en forced . R e a lis tic a lly , such a clause does not e lim in a te th e p lan 's fin a n c ia l b u rd e n fo r subprovider m a lp ra c tic e . T h e b u rd e n and m otivation on th e p lan rem ains in ta c t b e ­cause the clauses have th e ir o w n costs. In d e m n ific a tio n clauses re a lly o n ly s h ift and m odify th e b u rd e n w ith in th e G P H P . T h e cost o f m a lp ra c tic e w il l still f i l te r th ro u g h to the plan in th e fo rm o f increased fees subproviders w ill d em an d in re tu rn fo r in d em n ify in g th e G P H P

119 . T u n k l v R egents o f U n iv . o f C a l., 60 C al.2d 9 2 , 3 2 C a l. R p tr . 3 3 , 3 8 3 P .2d 441 (1 9 6 3 ); A n n o t ., supra n o te 1 1 8 , a t 701

120 . As to th is im p o r ta n t d u ty , see Beeck v Tu c so n G en . H o sp ., 18 A r iz . A p p . 165, 5 0 0 P .2d 1 1 5 3 , 1 1 5 7 (1 9 7 2 ) , w h e re the A rizo n a c o u rt said:

Having u n d e rta k e n o n e o f m a n k in d 's m ost c r it ic a lly im p o r ta n t and d e lic a te fie lds o f en d eavo r, c o n c o m ita n t ly th e re w ith th e h o s p ita l m u st assum e th e grave res p o n s ib ility o f pursu ing th is calling w ith a p p ro p r ia te care. T h e care and service dispensed th ro u g h th is high tru s t, h o w ever te c h n ic a l, c o m p le x and esoteric its c h a ra c te r m ay be, m ust m eet s tandards o f res p o n s ib ility c o m ­m ensurate w ith th e u n d e rta k in g to preserve and p ro te c t and h e a lth , and indeed, th e very lives o f those p laced in th e h o s p ita l's kee p in g . D a rlin g v C h a r le s t o n C o m m u n ity M e m o ria l Hosp., 3 3 I I I .2d 3 2 6 , 2 1 1 N .E .2 d 2 5 3 (1 9 6 5 )

121 . H ansen, supra n o te 1 5 , a t 5 4 41 2 2 . F io re n tin o v W enger, 19 N .Y .2 d

407 , 2 8 0 N .Y .S .2 d 3 7 3 , 2 2 7 N .E .2 d 2 9 6(1967)

123 . S m ith v D u k e U n iv e rs ity , 2 1 9 N .C . 628 , 1 4 S .E .2 d 6 4 3 , 6 4 7 (1 9 4 1 ) ; see also A n n o t., 7 2 A .L .R .2 d 3 9 6 (1 9 6 0 )

124 . 3 3 I I I .2 d 3 2 6 , 2 1 1 N .E .2 d 2 5 3 , 256 (1 9 6 5 )

125 . Beeck v T u c so n G en . H osp. 18 Ariz. A p p . 1 6 5 , 5 0 0 P .2d 1 1 5 3 , 1 1 5 8 (1 972 )

126 . M o st o f th e to p ic s re le v a n t to th is heading have p rev io u s ly been discussed. See tex t acc o m p an y in g notes 2 1 -2 5 ; 7 7 -1 0 2 ; and 1 0 9 -1 2 5

127 . W . C u rran & G . M o se ley , supra note 10 , a t vo l. 19

128 . See te x t a c c o m p a n y in g notes 8 7 - 90

129 . F o r an e x p la n a tio n o f “ c a p ita t io n contracts" see t e x t a c c o m p a n y in g n o te 2 0

130 . A G P H P o ffic ia l a d m itte d th a t his p lan /subprov ider c o n tra c t, w h e re b y th e physicians share in th e savings th a t o cc u r if less m edical care is p ro v id ed th a n w as projected and paid fo r , “ . . . c o u ld lead th e doctors to c u t back on care o r a t least be extra e ffic ie n t in o rd e r to increase th e savings p o o l." W. C u rran & G . M o se ley , supra no te 1, a t 8 0 , 8 1 ; see also id . S u p p . A . at 23

131 . See te x t a c c o m p a n y in g n o te 1 6 0 for an e x p la n a tio n o f w h y p lan l ia b i l ity also reduces th e m o tiv a tio n on phys ic ians to practice defense m ed ic in e

132 . F. H a rp er & F . Jam es, T h e L a w o f Torts 7 4 2 -4 3 (1 9 5 6 )

133. O th e r ra tio n a les fo r t o r t law have, of course, been advanced . See eg, F le tc h e r,

Fairness & U t i l i t y in T o r t T h e o ry , 8 5 H a rv . L . R ev. 5 3 7 (1 9 7 2 )

1 3 4 . F o r e x a m p le , see te x t a c c o m p a n y ­ing notes 2 1 -7 1 and 9 1 -1 3 2

1 3 5 . See te x t a cc o m p an y in g notes 12 9 -IS O

1 3 6 . F o r e x a m p le , in d e m n ific a tio n clauses and q u a lity c o n tro l p rocedures

1 3 7 . See eg, W . C u rran & G . M o se ley , supra n o te 1, a t S u p p le m e n t A page 2 3 ; H a vig h u rst & T a n c re d i, “ M ed ica l A d v e rs ity In su ran ce " — A N o -F a u lt A p p ro a c h to M edica l M a lp ra c tic e and Q u a lity A ssurance , 6 1 3 Ins. L. J. 6 9 , 9 3 (1 9 7 4 ) argues fo r n o -fa u lt l ia b il ity in such a s itu a tio n : H a v ig ­hurst, H M O 's and th e M a rk e t fo r H e a lth Services, 3 5 L a w and C o n te m p . P rob . 7 1 6 a t 7 5 5 ( 1 9 7 0 ) ; W . C u rran & G . M o s e le y , supra n o te 9 3 , a t 2 2

1 3 8 . See t e x t a c c o m p a n y in g notes 8 7 -8 9 and 1 2 6 -1 3 2

1 3 9 . F o r a d e ta ile d e x p la n a tio n o f th is , see F . H a rp e r & F . Jam es, supra n o te 1 3 2 , a t 7 5 6 , 7 5 7 ; fo r a sp ec ific G P H P e x a m p le o f these p rin c ip les , see th e t e x t a cc o m p an y in g n o te 8 8 , supra

1 4 0 . A lso see te x t a cc o m p an y in g notes 3 8 -7 0 and 1 2 1 -1 2 5

1 4 1 . W . C u rra n & . G . M o se ley , supra n o te 1, a t ix

1 4 2 . Id . a t 9 6 ; M ed ica l G ro u p M an ag e­m e n t Ass'n M a n u a l on Insurance , supra n o te 1 1 , a t 41

1 4 3 . F . H a rp e r & F. Jam es, supra n o te 1 3 3 , a t 1 2 9 9

1 4 4 . Id . a t 4 (V o l. 2 S u p p .)1 4 5 . W . C u rra n & G . M o se ley , supra

n o te 1, a t iv1 4 6 . Id . a t vii1 4 7 . C . F. R e s ta te m e n t (S eco n d ) o f

T o rts § 4 0 2 A , c o m m e n t C1 4 8 . In te rv ie w w ith L . M ich ae l M essina,

Esq., P a rtn e r o f M c R a e & M essina, in A lb u q u e rq u e , N e w M e x ic o , A p r il 2 6 , 1 9 7 4

1 4 9 . See A n n o t ., 8 9 A .L .R .2 d 1 1 8 0 (1 9 6 3 )

1 5 0 . See g e n e ra lly , A n n o t ., supra n o te 6 2 , a t 8 7 9

1 5 1 . See te x t a c c o m p a n y in g notes 135 -1 4 2

1 5 2 . F . H a rp er & F . Jam es, supra n o te 1 3 3 , a t 7 4 6 , 7 4 7

1 5 3 . See id . a t 7 5 2 -5 31 5 4 . F o r e x a m p le , w o rk m a n 's c o m p e n ­

sation law s p ro v id e such a system . Id . a t 7 5 3 . T h e general ana lysis o f th e m ora l ju s tif ic a tio n fo r ac c id e n t law in th is section ow es m uch to Professors H a rp e r and Jam es

1 5 5 . A n d a c o n c o m ita n t s u b je c tific a tio n o f th e standard ap p lied to p la in tif fs , Id . a t 7 4 6

1 5 6 . D a rlin g v C h arles to n C o m m u n ity M e m o ria l H o sp ., 5 0 I II . A p p .2d 2 5 3 , 2 0 0 N .E .2 d 1 4 9 (1 9 6 4 ) a f fd , 3 3 lll .2 d 2 3 6 ,2 1 1 N .E .2 d 2 5 3 (1 9 6 5 ) . ce rt, d e n ie d , 3 8 3 U .S . 9 4 6 (1 9 6 6 )

1 5 7 . W . C u rran & G . M o s e le y , supra n o te 1 0 , a t 13

1 5 8 . See n. 4 , supra1 5 9 . See te x t a c c o m p a n y in g notes 8 7 -

9 0 and 1 2 6 -1 2 81 6 0 . F o r a 1 9 5 7 c o u rt's re je c tio n o f th is

sam e baseless w o r ry , see Bing v T h u n ig , 2 N .Y .2 d 6 5 6 , 1 6 3 N .Y .S .2 d 3 , 1 4 3 N .E .2 d 3 (1 9 5 7 )

1 6 1 . See S o u th w ic k , sup a n o te 1 2 , a t 4 4 0 -4 4 3 and 4 5 2 -4 5 3

1 6 2 . See: C e n te r fo r th e S tu d y o f D e m ­o cra tic In s titu t io n s , M ed ica l M a lp ra c tic e — A Discussion o f A lte rn a t iv e C o m p en satio n a n d Q u a li ty C o n tro l System s, 1 3 -1 8 (N o v e m b e r, 1 9 7 1 ); E llw o o d , Im p lic a tio n s o f R e cen t H e a lth L eg is la tio n , A m e r . J . Pub. H e a lth 2 0 , 21 (J a n u a ry , 1 9 7 2 ); W . C u rran & G . M o se ley , supra n o te 1, S u pp . A a t 76

1 6 3 . See R u b sam en , T h e E x p erien ce o f B ind ing A rb it ra t io n in th e R o ss-Loos M e d i­cal G ro u p , in R e p o rt o f th e S e c re ta ry 's C om m iss ion on M ed ica l M a lp ra c tic e ; A p p e n ­d ix a t 4 2 1 ; C e n te r fo r th e S tu d y o f D e m o ­cra tic In s titu t io n s , supra n o te 1 6 2 , a t 8; M edical G ro u p M a n a g e m e n t A s so c ia tio n , supra n o te 1 1 , a t 7 7 , H e n d erso n , C o n tra c ­tua l P ro b lem s in th e E n fo rc e m e n t o f A g re e ­m ents to A rb it ra te M ed ica l M a lp ra c tic e , 5 8 V a . L . Rev. 9 4 7 (1 9 7 2 ) ; and W . C u rran & G. M o se ley , supra n o te 1 , a t v, v i, 4 2 , A p p e n ­dices 3 and 4 , S u p p . A a t 2 6 -2 8

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